P4506New indices of arterial stiffness correlates with disease severity and mid-term prognosis in acute decompensated heart failure

Abstract

Abstract Background Arterial stiffness has been implicated in pathophysiology of heart failure (HF) since it is involved in the ventricular-vascular coupling. Recently, new indices obtained by a cuff oscillometric technique, the arterial velocity-pulse index (AVI) for the stiffness of central arteries and the arterial pressure-volume index (API) for the stiffness of peripheral arteries have been developed and validated. However, the AVI and API measurement has not been attempted in HF population. Purpose This study aimed to investigate the relationship between the AVI, API and clinical outcomes in HF patients. Methods A prospective cohort of patients with acute decompensated HF were enrolled within 6 months, who were admitted to a tertiary referral hospital in China. Measurement of the AVI and API (AVE-1500, Shisei Datum, Tokyo, Japan) was performed on the day of admission and discharge. Patients were followed up to 6 months for the composite endpoint of all-cause death and HF rehospitalization. Results A Total of 127 patients were recruited for analysis (60±15 years, 70% male). 80% of the patients were in New York Heart Association (NYHA) Class III or above at admission, who presented a mean left ventricular ejection fraction (LVEF) of 34±9%. During hospitalization, all patients received guideline directed medical therapy if not contraindicated. The AVI (27.3±5.2 vs. 28.6±6.7, p=0.002) and API (24.9±4.9 vs. 26.0±6.5, p=0.05) were lower at discharge than at admission. By dividing the patients into tertiles according to the amino-terminal pro-brain natriuretic peptide (NT-proBNP), LVEF, transmitral E velocity over mitral annular e' velocity (E/e' ratio) and systolic blood pressure (SBP) at admission, it was observed that the AVI increased with a higher level of NT-proBNP (p for trend <0.001), a larger E/e' (p<0.001) and a lower LVEF (p=0.001), while the API increased as the SBP became higher (p=0.005).The improvement in AVI at discharge was correlated with that in LVEF (R=-0.3024, p<0.05) and NT-proBNP (R=0.3118, p<0.05), while the change in API was positively correlated with that in SBP (R=0.3897, p<0.001). In 6 months after discharge, there were 52 predefined events including 15 deaths and 44 HF rehospitalization. Apart from the level of NT-proBNP, the AVI at discharge of ≥26 showed a trend of being associated with the composite outcome (2.747, 1.411–5.349, p<0.001 for univariate analysis; 1.8648, 0.8928–3.8949, p=0.0973 for multivariate analysis). Conclusions New noninvasive arterial stiffness indices as the AVI and API reflected severity of illness and mid-term prognosis in admitted HF patients. Further studies are warranted for understanding its mechanisms and developing clinical applications.